Youth who use prescription drugs and alcohol at the same time are at increased risk for more severe intoxication, injury, overdose, and mortality. This study examined how co-use is related to the prevalence of substance use disorder and if key life experiences play any role in co-use.
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Youth who experiment with substances often do not limit their experimentation to use of a single substance at a time. This co-use of substances can be especially dangerous for several reasons. First, youth may be unaware of how substances will interact and the consequences of those interactions. When using substances, judgement for whether to engage in further substance use, and to what degree, often becomes impaired, and many drugs produce disinhibiting effects, increasing the risk for heavier use and more severe intoxication. Prescription drugs such as opioids or benzodiazepines that suppress the central nervous system can be particularly dangerous when used with alcohol which is also a central nervous system depressant. As a result, combined use (i.e., co-ingestion) of certain substances such as prescription drugs and alcohol can substantially increase the risk for overdose and fatality.
The use of any substance and the co-use of substances may also vary by youth’s experiences in their surrounding environment and their degree of protective and risk factors. For example, youth who feel they do not have someone to support them when faced with a problem or perhaps have a stressful or conflict-filled relationship with their parents may be more likely to use substances to cope with these stressors. Alternatively, spirituality or religion may serve as a protective factor, through either the social bonds provided by faith communities or internal motivation and rewards (hope, faith).
This study examined the prevalence of co-use of alcohol and the problematic use of prescription drugs among youth in the United States, with a focus on if the prevalence of a substance use disorder varied by whether or not youth co-used prescription drugs and alcohol. Finally, the study also examined the relationship between substance co-use and several important life experiences for youth: youth’s relationship with parents, religiosity, social support through a close friend, involvement in conventional activities (school, community, faith-based), and school status to help identify risk and protective factors for prescription drug and alcohol co-use.
This study was a secondary data analysis, using four years of data collected through the National Survey on Drug Use and Health (2015-2019). Although this is a national sample drawn from the US population of individuals 12 and older, the authors used a subset of all participants who were 12-17 years old.
A primary variable in this study was problematic prescription drug use, that is, whether or not youth had used a prescription drug either without a prescription or in a way other than a doctor had prescribed it, i.e., by using it in a “greater amounts, more often, or longer than you were told to take it.” If participants answered “yes” to this question, they were then asked about whether they drank alcohol at the same time or within a few hours of using a prescription drug (i.e., co-ingestion or co-use).
Substance use disorder was assessed by interview based on DSM-IV diagnostic criteria. In addition to demographic characteristics, participants were also asked about parent support (e.g., “parents tell you they are proud”), conflict with parents, parent disapproval of alcohol use, involvement in “conventional activities” (school, community, faith-based or other activities), religiosity, having someone to talk to about serious problems, school status, past year substance use, emergency department visits, major depression, and an overall rating of health.
In this analysis, the authors examined lifetime, past-year, and past 30-day problematic prescription drug use, co-use with alcohol, presence of a substance use disorder, and whether certain life experiences and demographic characteristics were related to higher or lower odds of problematic prescription drug use and alcohol co-use while controlling for other key participant characteristics (e.g., sex, age, race, ethnicity, and family income).
Of the analytic sample of 57,352 youth, 51% were male, just over half were White (54%), and about 14% reported experiencing symptoms of major depression.
Though problematic prescription drug use is uncommon, these youth are at high risk for a substance use disorder.
Among this nationally-representative sample of youth, there was low problematic prescription drug use: only 10% of youth reported using a prescription drug in a way not recommended by their doctor during their lifetime, with 1.5% reporting this experience in the past 30-days. Of youth who reported problematic use of a prescription drug in the past 30 days, 19% reported co-use with alcohol.
Youth who co-used alcohol and prescription drugs were more likely to meet criteria for a substance use disorder. Among youth with past 30-day problematic use of prescription drugs, 77% of those who co-used alcohol had a substance use disorder, while only 44% who did not co-use alcohol had substance use disorder. With respect to specific types of prescription drug use, the group that co-used tranquilizers with alcohol had the highest incidence of substance use disorder (86%), compared to those who used opioids (78%) or stimulants (67%) with alcohol. Youth with an alcohol use disorder had the highest prevalence of past 30-day prescription drug and alcohol co-use (60%) compared to the prevalence of co-use among youth with other substance use disorders (Marijuana, 47%; Cocaine, 12%; Heroin, <1%; Hallucinogen, 15%; Inhalant, 7%; Methamphetamine, <1%).
Key life experiences associated with problematic prescription drug use similar for those with and without alcohol co-use.
When directly comparing problematic prescription drug use among those who co-use with alcohol and those who do not, there do not appear to be any differences in the key experiences of those groups, except in the use of other substances. Among youth who co-use prescription drugs with alcohol, the risk for using marijuana, tobacco, and other drugs (aggregated across all drug types, e.g., cocaine, heroin, hallucinogens, etc.) was over double that of youth who did not co-use prescription drugs with alcohol.
Youth who report co-use of prescription drugs and alcohol were slightly more likely to report parent conflict and dropping out of school. They were also slightly more likely to be older, have major depression, and have two or more visits to the emergency department. Alternatively, if they reported higher religiosity and having a friend to talk to, they were slightly less likely to engage in prescription drugs and alcohol co-ingestion.
Youth who report problematic prescription drug use but not alcohol co-use were more likely to use stimulants if they were involved in conventional activities (e.g., school, community, faith-based or other activities), had been to the emergency department, or experienced major depression. Youth who had more parent support and parents who disapproved of alcohol use were less likely to report problematic prescription drug use across several types of prescription drugs.
In this nationally representative sample of over 50,000 youth, the past 30-day prevalence of problematic prescription drug use was low, at only 1.5%. Of youth who reported engaging in problematic prescription drug use in the past 30 days, nearly one quarter drank alcohol at the same time. Yet, because these are population-level data, this means that in any given year it is likely that nearly 70,000 youth in the United States engage in co-use of problematic prescription drugs and alcohol. This study also indicates that three-quarters of youth who engage in the co-use of problematic prescription drugs and alcohol have a substance use disorder and therefore may need direct connection to treatment services. Many of the risk factors that are linked to increased substance use are also related to the co-use of problematic prescription drugs and alcohol, including parent conflict, dropping out of school, experiencing major depression, and emergency department visits.
While prescription drugs that can be used problematically are prescribed for legitimate purposes – even to youth – for pain management or to address mental health conditions such as anxiety or ADHD, particularly when used without a prescription or not as prescribed, they can have both immediate as well as lasting consequences. The co-use of prescription drugs and alcohol appear to be a marker of a more severe clinical profile which includes a diagnosis of a substance use disorder and elevated risk of using other substances. Identifying ways to reduce access to these substances through physicians and pharmacists and early identification and referral to treatment may be the most effective way to curb the dangers associated with co-use of prescription drugs and alcohol among youth. Screening initiatives targeting youth substance use could also be improved by incorporating an item on co-use of prescription drugs and alcohol to identify these more severe clinical cases.
In this nationally representative sample of United States youth, 1.5% engaged in problematic prescription drug use in the past month, and of those, nearly one quarter drank alcohol at the same time. Youth who co-ingest prescription drugs and alcohol are nearly twice as likely to have a substance use disorder and need early and direct linkage for further assessment and treatment. Many of the risk factors for co-use are those related to increased substance use, including parent conflict, dropping out of school, experiencing major depression, and emergency department visits.
Ford, J. A., McCabe, S. E., & Schepis, T. S. (2023). Prescription Drug Misuse with Alcohol Coingestion among US Adolescents: Youth Experiences, Health-related Factors, and Other Substance Use Behaviors. Journal of Addiction Medicine, [Epub ahead of print]. doi: 10.1097/ADM.0000000000001131
l
Youth who experiment with substances often do not limit their experimentation to use of a single substance at a time. This co-use of substances can be especially dangerous for several reasons. First, youth may be unaware of how substances will interact and the consequences of those interactions. When using substances, judgement for whether to engage in further substance use, and to what degree, often becomes impaired, and many drugs produce disinhibiting effects, increasing the risk for heavier use and more severe intoxication. Prescription drugs such as opioids or benzodiazepines that suppress the central nervous system can be particularly dangerous when used with alcohol which is also a central nervous system depressant. As a result, combined use (i.e., co-ingestion) of certain substances such as prescription drugs and alcohol can substantially increase the risk for overdose and fatality.
The use of any substance and the co-use of substances may also vary by youth’s experiences in their surrounding environment and their degree of protective and risk factors. For example, youth who feel they do not have someone to support them when faced with a problem or perhaps have a stressful or conflict-filled relationship with their parents may be more likely to use substances to cope with these stressors. Alternatively, spirituality or religion may serve as a protective factor, through either the social bonds provided by faith communities or internal motivation and rewards (hope, faith).
This study examined the prevalence of co-use of alcohol and the problematic use of prescription drugs among youth in the United States, with a focus on if the prevalence of a substance use disorder varied by whether or not youth co-used prescription drugs and alcohol. Finally, the study also examined the relationship between substance co-use and several important life experiences for youth: youth’s relationship with parents, religiosity, social support through a close friend, involvement in conventional activities (school, community, faith-based), and school status to help identify risk and protective factors for prescription drug and alcohol co-use.
This study was a secondary data analysis, using four years of data collected through the National Survey on Drug Use and Health (2015-2019). Although this is a national sample drawn from the US population of individuals 12 and older, the authors used a subset of all participants who were 12-17 years old.
A primary variable in this study was problematic prescription drug use, that is, whether or not youth had used a prescription drug either without a prescription or in a way other than a doctor had prescribed it, i.e., by using it in a “greater amounts, more often, or longer than you were told to take it.” If participants answered “yes” to this question, they were then asked about whether they drank alcohol at the same time or within a few hours of using a prescription drug (i.e., co-ingestion or co-use).
Substance use disorder was assessed by interview based on DSM-IV diagnostic criteria. In addition to demographic characteristics, participants were also asked about parent support (e.g., “parents tell you they are proud”), conflict with parents, parent disapproval of alcohol use, involvement in “conventional activities” (school, community, faith-based or other activities), religiosity, having someone to talk to about serious problems, school status, past year substance use, emergency department visits, major depression, and an overall rating of health.
In this analysis, the authors examined lifetime, past-year, and past 30-day problematic prescription drug use, co-use with alcohol, presence of a substance use disorder, and whether certain life experiences and demographic characteristics were related to higher or lower odds of problematic prescription drug use and alcohol co-use while controlling for other key participant characteristics (e.g., sex, age, race, ethnicity, and family income).
Of the analytic sample of 57,352 youth, 51% were male, just over half were White (54%), and about 14% reported experiencing symptoms of major depression.
Though problematic prescription drug use is uncommon, these youth are at high risk for a substance use disorder.
Among this nationally-representative sample of youth, there was low problematic prescription drug use: only 10% of youth reported using a prescription drug in a way not recommended by their doctor during their lifetime, with 1.5% reporting this experience in the past 30-days. Of youth who reported problematic use of a prescription drug in the past 30 days, 19% reported co-use with alcohol.
Youth who co-used alcohol and prescription drugs were more likely to meet criteria for a substance use disorder. Among youth with past 30-day problematic use of prescription drugs, 77% of those who co-used alcohol had a substance use disorder, while only 44% who did not co-use alcohol had substance use disorder. With respect to specific types of prescription drug use, the group that co-used tranquilizers with alcohol had the highest incidence of substance use disorder (86%), compared to those who used opioids (78%) or stimulants (67%) with alcohol. Youth with an alcohol use disorder had the highest prevalence of past 30-day prescription drug and alcohol co-use (60%) compared to the prevalence of co-use among youth with other substance use disorders (Marijuana, 47%; Cocaine, 12%; Heroin, <1%; Hallucinogen, 15%; Inhalant, 7%; Methamphetamine, <1%).
Key life experiences associated with problematic prescription drug use similar for those with and without alcohol co-use.
When directly comparing problematic prescription drug use among those who co-use with alcohol and those who do not, there do not appear to be any differences in the key experiences of those groups, except in the use of other substances. Among youth who co-use prescription drugs with alcohol, the risk for using marijuana, tobacco, and other drugs (aggregated across all drug types, e.g., cocaine, heroin, hallucinogens, etc.) was over double that of youth who did not co-use prescription drugs with alcohol.
Youth who report co-use of prescription drugs and alcohol were slightly more likely to report parent conflict and dropping out of school. They were also slightly more likely to be older, have major depression, and have two or more visits to the emergency department. Alternatively, if they reported higher religiosity and having a friend to talk to, they were slightly less likely to engage in prescription drugs and alcohol co-ingestion.
Youth who report problematic prescription drug use but not alcohol co-use were more likely to use stimulants if they were involved in conventional activities (e.g., school, community, faith-based or other activities), had been to the emergency department, or experienced major depression. Youth who had more parent support and parents who disapproved of alcohol use were less likely to report problematic prescription drug use across several types of prescription drugs.
In this nationally representative sample of over 50,000 youth, the past 30-day prevalence of problematic prescription drug use was low, at only 1.5%. Of youth who reported engaging in problematic prescription drug use in the past 30 days, nearly one quarter drank alcohol at the same time. Yet, because these are population-level data, this means that in any given year it is likely that nearly 70,000 youth in the United States engage in co-use of problematic prescription drugs and alcohol. This study also indicates that three-quarters of youth who engage in the co-use of problematic prescription drugs and alcohol have a substance use disorder and therefore may need direct connection to treatment services. Many of the risk factors that are linked to increased substance use are also related to the co-use of problematic prescription drugs and alcohol, including parent conflict, dropping out of school, experiencing major depression, and emergency department visits.
While prescription drugs that can be used problematically are prescribed for legitimate purposes – even to youth – for pain management or to address mental health conditions such as anxiety or ADHD, particularly when used without a prescription or not as prescribed, they can have both immediate as well as lasting consequences. The co-use of prescription drugs and alcohol appear to be a marker of a more severe clinical profile which includes a diagnosis of a substance use disorder and elevated risk of using other substances. Identifying ways to reduce access to these substances through physicians and pharmacists and early identification and referral to treatment may be the most effective way to curb the dangers associated with co-use of prescription drugs and alcohol among youth. Screening initiatives targeting youth substance use could also be improved by incorporating an item on co-use of prescription drugs and alcohol to identify these more severe clinical cases.
In this nationally representative sample of United States youth, 1.5% engaged in problematic prescription drug use in the past month, and of those, nearly one quarter drank alcohol at the same time. Youth who co-ingest prescription drugs and alcohol are nearly twice as likely to have a substance use disorder and need early and direct linkage for further assessment and treatment. Many of the risk factors for co-use are those related to increased substance use, including parent conflict, dropping out of school, experiencing major depression, and emergency department visits.
Ford, J. A., McCabe, S. E., & Schepis, T. S. (2023). Prescription Drug Misuse with Alcohol Coingestion among US Adolescents: Youth Experiences, Health-related Factors, and Other Substance Use Behaviors. Journal of Addiction Medicine, [Epub ahead of print]. doi: 10.1097/ADM.0000000000001131
l
Youth who experiment with substances often do not limit their experimentation to use of a single substance at a time. This co-use of substances can be especially dangerous for several reasons. First, youth may be unaware of how substances will interact and the consequences of those interactions. When using substances, judgement for whether to engage in further substance use, and to what degree, often becomes impaired, and many drugs produce disinhibiting effects, increasing the risk for heavier use and more severe intoxication. Prescription drugs such as opioids or benzodiazepines that suppress the central nervous system can be particularly dangerous when used with alcohol which is also a central nervous system depressant. As a result, combined use (i.e., co-ingestion) of certain substances such as prescription drugs and alcohol can substantially increase the risk for overdose and fatality.
The use of any substance and the co-use of substances may also vary by youth’s experiences in their surrounding environment and their degree of protective and risk factors. For example, youth who feel they do not have someone to support them when faced with a problem or perhaps have a stressful or conflict-filled relationship with their parents may be more likely to use substances to cope with these stressors. Alternatively, spirituality or religion may serve as a protective factor, through either the social bonds provided by faith communities or internal motivation and rewards (hope, faith).
This study examined the prevalence of co-use of alcohol and the problematic use of prescription drugs among youth in the United States, with a focus on if the prevalence of a substance use disorder varied by whether or not youth co-used prescription drugs and alcohol. Finally, the study also examined the relationship between substance co-use and several important life experiences for youth: youth’s relationship with parents, religiosity, social support through a close friend, involvement in conventional activities (school, community, faith-based), and school status to help identify risk and protective factors for prescription drug and alcohol co-use.
This study was a secondary data analysis, using four years of data collected through the National Survey on Drug Use and Health (2015-2019). Although this is a national sample drawn from the US population of individuals 12 and older, the authors used a subset of all participants who were 12-17 years old.
A primary variable in this study was problematic prescription drug use, that is, whether or not youth had used a prescription drug either without a prescription or in a way other than a doctor had prescribed it, i.e., by using it in a “greater amounts, more often, or longer than you were told to take it.” If participants answered “yes” to this question, they were then asked about whether they drank alcohol at the same time or within a few hours of using a prescription drug (i.e., co-ingestion or co-use).
Substance use disorder was assessed by interview based on DSM-IV diagnostic criteria. In addition to demographic characteristics, participants were also asked about parent support (e.g., “parents tell you they are proud”), conflict with parents, parent disapproval of alcohol use, involvement in “conventional activities” (school, community, faith-based or other activities), religiosity, having someone to talk to about serious problems, school status, past year substance use, emergency department visits, major depression, and an overall rating of health.
In this analysis, the authors examined lifetime, past-year, and past 30-day problematic prescription drug use, co-use with alcohol, presence of a substance use disorder, and whether certain life experiences and demographic characteristics were related to higher or lower odds of problematic prescription drug use and alcohol co-use while controlling for other key participant characteristics (e.g., sex, age, race, ethnicity, and family income).
Of the analytic sample of 57,352 youth, 51% were male, just over half were White (54%), and about 14% reported experiencing symptoms of major depression.
Though problematic prescription drug use is uncommon, these youth are at high risk for a substance use disorder.
Among this nationally-representative sample of youth, there was low problematic prescription drug use: only 10% of youth reported using a prescription drug in a way not recommended by their doctor during their lifetime, with 1.5% reporting this experience in the past 30-days. Of youth who reported problematic use of a prescription drug in the past 30 days, 19% reported co-use with alcohol.
Youth who co-used alcohol and prescription drugs were more likely to meet criteria for a substance use disorder. Among youth with past 30-day problematic use of prescription drugs, 77% of those who co-used alcohol had a substance use disorder, while only 44% who did not co-use alcohol had substance use disorder. With respect to specific types of prescription drug use, the group that co-used tranquilizers with alcohol had the highest incidence of substance use disorder (86%), compared to those who used opioids (78%) or stimulants (67%) with alcohol. Youth with an alcohol use disorder had the highest prevalence of past 30-day prescription drug and alcohol co-use (60%) compared to the prevalence of co-use among youth with other substance use disorders (Marijuana, 47%; Cocaine, 12%; Heroin, <1%; Hallucinogen, 15%; Inhalant, 7%; Methamphetamine, <1%).
Key life experiences associated with problematic prescription drug use similar for those with and without alcohol co-use.
When directly comparing problematic prescription drug use among those who co-use with alcohol and those who do not, there do not appear to be any differences in the key experiences of those groups, except in the use of other substances. Among youth who co-use prescription drugs with alcohol, the risk for using marijuana, tobacco, and other drugs (aggregated across all drug types, e.g., cocaine, heroin, hallucinogens, etc.) was over double that of youth who did not co-use prescription drugs with alcohol.
Youth who report co-use of prescription drugs and alcohol were slightly more likely to report parent conflict and dropping out of school. They were also slightly more likely to be older, have major depression, and have two or more visits to the emergency department. Alternatively, if they reported higher religiosity and having a friend to talk to, they were slightly less likely to engage in prescription drugs and alcohol co-ingestion.
Youth who report problematic prescription drug use but not alcohol co-use were more likely to use stimulants if they were involved in conventional activities (e.g., school, community, faith-based or other activities), had been to the emergency department, or experienced major depression. Youth who had more parent support and parents who disapproved of alcohol use were less likely to report problematic prescription drug use across several types of prescription drugs.
In this nationally representative sample of over 50,000 youth, the past 30-day prevalence of problematic prescription drug use was low, at only 1.5%. Of youth who reported engaging in problematic prescription drug use in the past 30 days, nearly one quarter drank alcohol at the same time. Yet, because these are population-level data, this means that in any given year it is likely that nearly 70,000 youth in the United States engage in co-use of problematic prescription drugs and alcohol. This study also indicates that three-quarters of youth who engage in the co-use of problematic prescription drugs and alcohol have a substance use disorder and therefore may need direct connection to treatment services. Many of the risk factors that are linked to increased substance use are also related to the co-use of problematic prescription drugs and alcohol, including parent conflict, dropping out of school, experiencing major depression, and emergency department visits.
While prescription drugs that can be used problematically are prescribed for legitimate purposes – even to youth – for pain management or to address mental health conditions such as anxiety or ADHD, particularly when used without a prescription or not as prescribed, they can have both immediate as well as lasting consequences. The co-use of prescription drugs and alcohol appear to be a marker of a more severe clinical profile which includes a diagnosis of a substance use disorder and elevated risk of using other substances. Identifying ways to reduce access to these substances through physicians and pharmacists and early identification and referral to treatment may be the most effective way to curb the dangers associated with co-use of prescription drugs and alcohol among youth. Screening initiatives targeting youth substance use could also be improved by incorporating an item on co-use of prescription drugs and alcohol to identify these more severe clinical cases.
In this nationally representative sample of United States youth, 1.5% engaged in problematic prescription drug use in the past month, and of those, nearly one quarter drank alcohol at the same time. Youth who co-ingest prescription drugs and alcohol are nearly twice as likely to have a substance use disorder and need early and direct linkage for further assessment and treatment. Many of the risk factors for co-use are those related to increased substance use, including parent conflict, dropping out of school, experiencing major depression, and emergency department visits.
Ford, J. A., McCabe, S. E., & Schepis, T. S. (2023). Prescription Drug Misuse with Alcohol Coingestion among US Adolescents: Youth Experiences, Health-related Factors, and Other Substance Use Behaviors. Journal of Addiction Medicine, [Epub ahead of print]. doi: 10.1097/ADM.0000000000001131
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